A nurse is working with a local group that is in the process of reducing the use of pesticides in community gardens. The nurse should identify that the group is in which of the following stages of change?

Rationale for correct choices

• Placental abruption: The client presents at 30 weeks gestation with sudden onset right upper abdominal pain, headache, nausea, vomiting, facial edema, and elevated blood pressure (148/94 mm Hg). These are classic signs of preeclampsia, which significantly increases the risk of placental abruption. Abruptio placentae involves premature separation of the placenta from the uterine wall, leading to maternal and fetal complications, making close monitoring essential.

• Hypertension: The client’s elevated blood pressure is a hallmark feature of preeclampsia and a key risk factor for placental abruption. Hypertension can impair placental perfusion, increasing the likelihood of placental separation. Prompt identification and management of elevated blood pressure are critical to prevent adverse maternal and fetal outcomes.

Rationale for incorrect choices

• Spontaneous abortion: Spontaneous abortion usually occurs before 20 weeks gestation, whereas this client is at 30 weeks. Current symptoms are more indicative of a hypertensive pregnancy disorder rather than early pregnancy loss, making this diagnosis unlikely.

• Oligohydramnios: There is no indication of reduced amniotic fluid volume on assessment, and fundal height is consistent with gestational age. Oligohydramnios would require ultrasound confirmation and is not suggested by the client’s current presentation.

• Placenta previa: Placenta previa is characterized by painless vaginal bleeding rather than abdominal pain and elevated blood pressure. The client’s symptoms of right upper quadrant pain, hyperreflexia, and hypertension point toward preeclampsia-related complications rather than placenta previa.

• Chorioamnionitis: Chorioamnionitis is an intra-amniotic infection typically associated with fever, uterine tenderness, and maternal/fetal tachycardia. This client is afebrile with normal fetal heart rate, making chorioamnionitis unlikely.

• Hyperreflexia: While hyperreflexia is present, it is a sign of preeclampsia rather than a direct risk factor for placental abruption. It supports the diagnosis but does not independently cause the abruption.

• Temperature: The client’s temperature is within normal limits. Fever is not present and therefore does not contribute to the risk of placental abruption.

• Fundal measurement: The fundal height (29 cm) is appropriate for gestational age and does not indicate a risk factor for placental abruption. Fundal height alone is not predictive of this complication.

• Vomiting: Although present, vomiting is a nonspecific symptom and a secondary sign of preeclampsia. It contributes to maternal discomfort but is not a direct risk factor for placental abruption.

A. Aspirin: Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that can irritate the gastric mucosa and increase the risk of gastrointestinal bleeding. It is contraindicated in clients with a history of peptic ulcer disease.

B. Ketorolac: Ketorolac is a very potent Non-Steroidal Anti-Inflammatory Drug (NSAID) usually given IV or IM. It carries a high risk of GI ulceration and perforation and is contraindicated in clients with active PUD or a high risk of GI bleeding.

C. Acetaminophen: Acetaminophen provides analgesic and antipyretic effects without significant gastrointestinal irritation. It is safe for clients with peptic ulcer disease, making it the preferred choice for headache management in this context.

D. Ibuprofen: Ibuprofen, like other NSAIDs, can exacerbate peptic ulcer disease by inhibiting prostaglandin synthesis and increasing the risk of GI bleeding, so it should be avoided in clients with a history of ulcers.